Table of Contents
Medical texts from ancient Mesopotamia stand in a wider tradition of scribal scholarship, including texts that deal with astronomy and astrology, mathematics, and law. The main characteristics of scholarly texts and, in particular, those that deal with the sciences, provide a context for the study of form and content of medical texts. For example, medical texts employ the casuistic formula and, rather than setting down general theories, present concrete descriptions of medical problems, whether these were once observed or merely theorised. The ways in which symptoms and diseases are described and arranged in the medical texts reflect the methods of Mesopotamian scholarship more generally, and these works seem to reflect an attempt by scholars to make sense of the world around them and to organize it into a comprehensible framework.
The Kassite, or Middle Babylonian, period was especially important in the long-term process of standardisation and canonisation of such texts. Although the process by which works of the scientific disciplines reached their final form is not explained or even mentioned in the sources, it is thought to be the work of Kassite period transcribers and editors, since many representative texts of the scholarly tradition emerged from the library of Tiglath-Pileser I (who ruled from 1115-1107 BC) – so they emerged in essentially the same form in which they are attested in the Neo-Assyrian and Neo-Babylonian copies.
The oldest known complete medical text is from about 2000 BC and is in Sumerian ([LINK]; see also Civil). A therapeutic text that deals with many types of misfortunate, among them medical problems like headaches, it is also the only known medical text in Sumerian to date. The rest of the known sources for the study of Mesopotamian medicine are in Akkadian.
The text SA.GIG, or Sakikkû, which translates loosely to “symptoms”, is considered to be the canonical diagnostic series in Akkadian, comprised of 40 tablets arranged into six chapters, which was compiled and edited by the scribe and scholar Esagil-kīn-apli during the reign of Adad-apla-iddina (1067-1046 BC). Known to modern scholars as the Diagnostic Handbook, the work provides information about symptoms, disease names, prognosis, and disease causation. Middle Babylonian diagnostic texts that differ from the main Diagnostic Handbook may represent forerunners to this canonical text or a competing tradition.
A typical entry from the Diagnostic Handbook employs the casuistic formula, whereby the protases presents information about symptoms, patients, and the course of the illness, and the apodosis gives some combination of a diagnosis, cause, and prognosis. Below is an excerpt from Tablet 9, which forms part of the second chapter of the Diagnostic Handbook and deals with symptoms relating to the face. The entries from this excerpt showcase the typical structure of a diagnostic entry:
"If [symptom(s)], then [diagnosis and/or aetiology]; [prognosis]."
The excerpt also shows how entries relate to one another in a typical sequence. A typical series of entries will elaborate on a basic symptom by adding variables to it or varying the symptom itself to attempt to account for all possible permutations. For example, in lines 9-13 below, the basic symptom is that one side of the body is "let down". The entries begin with the right side, elaborate this as referring to the entire right side, and then move on to the left side. This expansion is typical of scholarly texts more generally, which follow certain schemata in order to cover all observed and imagined scenarios.
|1.||[DIŠ NA mi-šit-ti pa-ni] ˹ma˺-šid-ma ta-lam-˹ma˺-šu2 i-šam-ma-am-šu2 ˹KIN˺ mi-šit-ti||If a man has been struck by a stroke of the face and his torso(?) is paralysed: the 'work' of a stroke.|
|2.||DIŠ ˹miš˺-[šit-ti im]-šid-su-ma ib-ta-luṭ SAG.KI-šu2 DIB.DIB-su u MUD.MUD-˹ud||If a stroke has struck him and he has recovered again, but his forehead seizes him all the time and he is apprehensive all the time:|
|3.||mu-kil˺ SAG-šu nu pa-ṭir||(it is) his providing spirit; it will not be released.|
|4.||DIŠ mi-šit-ti im-šid-su-ma SAG.KI-šu2 DIB.DIB-su mu-kil SAG-šu2 ina-ṭal / SAG.ḪUL.ḪA.ZA IGI GAM||If a stroke has struck him and his forehead seizes him all the time, he sees his providing spirit; variant: he sees the Provider-of-Evil; he will die.|
|5.||DIŠ mi-šit-ti im-šid-su-ma lu XV lu CL SIG3-iṣ MUD A2-šu2 NU pa-ṭir||If a stroke has struck him and he is being hit either on the right or on the left side, his upper arm not moving freely (?),|
|6.||ŠU.SI.MEŠ-šu2 NIR.NIR-aṣ ŠU-su u2-šaq-qa2 u NIR-aṣ GIR3-šu2 i-kan-na-an u NIR-aṣ||he stretches his fingers all the time, he puts up (?) his hand and stretches it, he contorts and stretches his foot,|
|7.||˹NINDA˺(!) u KAŠ NU TAR-us DIB GUD DIŠ(!) EDEN III KAM NI ŠI||he does not…bread or beer: seizure by a Spirit of the Plains; three…he will recover.|
|8.||DIŠ ˹ka-bit˺-ma lu ŠU-su lu GIR3-šu2 ik-ta-na-an mi-šit-ti im-šid-su DIN||If he, being heavy, contorts either his hand or his foot: a stroke has struck him; he will recover.|
|9.||DIŠ ZAG-šu2 tab-kat2 mi-šit-ti MAŠKIM DIN||If his right side is let down: stroke (inflicted by) a Lurker; he will recover.|
|10.||[DIŠ] ˹ZAG˺ LU2.BAD-šu2 ka-lu-šu2-ma tab-kat2 mi-šit-ti MAŠKIM EGIR-tu2 SIG3-iṣ||If the right side of his body is in its entirety let down: stroke (inflicted by) a Lurker; he has been hit at the rear.|
|11.||[DIŠ] ˹GUB3˺-šu2 tab-kat2 ŠU dŠu-lak||If his left side is let down: Hand of Šulak.|
|12.||DIŠ ˹GUB3˺ LU2.BAD-šu2 ka-lu-šu2-ma tab-kat2 GABA.RI SIG3-iṣ ŠU dŠu-lak||If the left side of his body is let down in its entirety: he has been hit at the front; Hand of Šulak,|
|13.||MAŠKIM mu-sa-a-ti MAŠ.MAŠ ana DIN-šu2 ME.A NU GAR-an||Lurker of the bathroom. An āšipu shall not make a prognosis for his recovery.|
While the Diagnostic Handbook provided an important tool to physicians, it lacked instructions for the treatment of illnesses and conditions, which come from therapeutic texts. The main component of a therapeutic text is the therapy itself. Other components can appear in a therapeutic text, and the following basic structure can be identified where these components occur:
|1.||Symptomatology||e.g., "If a man suffers from headache and chills"|
|2.||Diagnosis||e.g., "It is lubāṭu-illness"|
|3.||Aetiology||e.g., "He was struck by Ghost Wandering at Night"|
|4.||Treatment||e.g., instructions for applying a salve; performing a ritual with an incantation; list of plants to use in a decoction|
|5.||Prognosis||e.g., "He will recover"|
In general, while therapeutic texts can be diverse in format and content, they most often include elements 1,2, and 3, which together can be grouped under the label of a diagnostic introduction, setting out the symptoms and condition for which treatment is being sought, as well as element 4, which can include medical prescriptions and/or magical elements. A symptomatology may describe multiple conditions, rather than a single unified disease or illness, which allows for the therapeutic texts to accommodate diverse experiences of clients and patients who may suffer from one or a combination of the complaints listed.
With respect to canonical works of medical therapies, a Therapeutic Handbook is now known from Neo-Assyrian copies.
The following example of a therapeutic text preserves all of the elements listed above.
BAM 1, 076 is an example of a much shorter therapeutic text that lists plants to be used for headaches.
These are commentaries on specific words, phrases, or passages from the Diagnostic Handbook and other medical texts. Because these texts come from periods much later than those in which their source text – or the original text on which they comment, such as the Diagnostic Handbook – were written down, they must be treated with care. At times, they reflect a lack of understanding on the part of later scribes. However, they can also reveal aspects of medical theory and principles of scholarly interpretation more generally.
Typically, a medical commentary will give a sign, word, or phrase from the source text, followed by a synonym, definition, exegesis, or explanation. For example, if the sign or word from the source text is Sumerian, an Akkadian equivalent may be given. The hermeneutic principles and other features of commentaries are treated extensively in Frahm's recent study, Babylonian and Assyrian Text Commentaries.
|1.||SI.DARA4.MAŠ : qar-nu a-a-lu : SI : qar-nu : DARA3.MAŠ : a-a-lu : DIŠ : šum-mu : AN.TA.ŠUB.BA : mar-ṣa iḫ-tan-naq u3 UḪ2-su ŠUB.ŠUB-a : AN.TA.ŠUB.BA|
|2.||dLUGAL.NIR.RA : IGI.II 15-šu2 u 150-šu2 i-kap-pi-iṣ dLUGAL.NIR.RA : ŠU.DINGIR.RA : DINGIR.MEŠ i-nam-zar šil-lat i-qab-bi ša2 im-mar i-maḫ-ḫaṣ ŠU.DINGIR.RA : ŠU.dININ.NA :|
|3.||ḫu-uṣ-ṣi GAZ ŠA3 TUKU.TUKU-ši u3 INIM.MEŠ-šu2 im-ta-na-aš2-ši ŠU.dININ.NA : ŠU.GIDIM.MA GEŠTUG.II.MEŠ-šu2 GU3.DE2.MEŠ ma-gal iṭ-ṭe3-ne2-pi šin-na-šu2 ana ma-ka-le-e|
There are numerous other sources for the study of medical traditions, practices, illness, and health in ancient Mesopotamia. Letters, for example, can include descriptions of medical problems, especially those between the Neo-Assyrian king Esarhaddon and his royal physicians and scholars. Literary texts contain references to illnesses and symptoms that can sometimes be linked with those that appear in the Diagnostic Handbook. In addition, there is one lexical series dedicated to the human body known as UGU.MU, and lists of diseases, including the Old Babylonia List of Diseases and a Standard Babylonian recension of the same. However, strictly speaking, medical texts are confined to the ones detailed in the above typology.